Internet Banking Enrollment Form

Transcription

1 Internet Banking Enrollment Form Billing Method: Analysis Charged Waived Billing Account Number: Service Option Packages - Choose one Service Option Package and the optional service(s) under each. Option A Internet Banking Standard Features: Balance Reporting, Check Images, Secure and Statements. Optional Features: Stop Payments Option B Internet Banking with Wire Transfer Standard Features: Balance Reporting, Check Images, Secure , Statements and Wire Transfer. Optional Features: Positive Pay Special Reports Stop Payments Page 1 of 6

2 Customer Address: SSN #: PERSONAL INFORMATION Phone: City, State & ZIP: Address: NIC #: Primary Business Address: BUSINESS INFORMATION Phone: Fax: City, State & ZIP: NIC #: Agent Agent Agent ACCOUNT INFORMATION Account Number Port Number DDA//SAV/LOAN/COD Short Name ID* * Short Name Identification: The Short Name Identification is used to help you easily identify your account numbers. As an example, checking account could be described as CHECKING, or as the actual account number based upon your preference. Page 2 of 6

3 USER NAME: GENERAL ACCOUNT ACCESS RIGHTS FOR USER ADDRESS: SECRET PASSWORD OR PHRASE (Used to identify the user over the telephone): TELEPHONE NUMBER: ACCOUNT SHORT NAME/ID NONE account information or VIEW ONLY statements/cannot DEPOSIT ONLY account information/ VIEW/DEPOSIT statements/ability to FULL Internal transfer access/ perform granted Cash Management functions. ADMINISTRATOR Full account, Cash Management access/ change user access. CASH MANAGEMENT FUNCTION Cash Concentration Controlled Disbursement Positive Pay Special Reports Wire Transfer CASH MANAGEMENT TRANSACTION RIGHTS FOR USER SETUP DRAFT AUTHORIZE DAILY TRANSACTION DOLLAR LIMIT *Balance inquiries for Certificates of Deposit are available with View Only capability. Statements are available online for checking accounts only. Full or Administrator access to loan accounts allows the user to make loan payments only. Users desiring access to Cash Management functions must have Full or Administrator access to the applicable accounts to perform these functions. Page 3 of 6

4 USER NAME: GENERAL ACCOUNT ACCESS RIGHTS FOR USER ADDRESS: SECRET PASSWORD OR PHRASE (Used to identify the user over the telephone): TELEPHONE NUMBER: ACCOUNT SHORT NAME/ID NONE account information or VIEW ONLY statements/cannot DEPOSIT ONLY account information/ VIEW/DEPOSIT statements/ability to FULL Internal transfer access/ perform granted Cash Management functions. ADMINISTRATOR Full account, Cash Management access/ change user access. CASH MANAGEMENT FUNCTION Cash Concentration Controlled Disbursement Positive Pay Special Reports Wire Transfer CASH MANAGEMENT TRANSACTION RIGHTS FOR USER SETUP DRAFT AUTHORIZE DAILY TRANSACTION DOLLAR LIMIT *Balance inquiries for Certificates of Deposit are available with View Only capability. Statements are available online for checking accounts only. Full or Administrator access to loan accounts allows the user to make loan payments only. Users desiring access to Cash Management functions must have Full or Administrator access to the applicable accounts to perform these functions. Page 4 of 6

5 SPECIAL INSTRUCTIONS Page 5 of 6

6 Authorization and Agreement Internet Banking Enrollment Form - Continued By signing below, I hereby apply for Netteller Service and authorize you and your agents and assigns to provide the Service for the 1 st National Bank St. Lucia Limited accounts designated. I understand that the use of the Service is subject to the terms and conditions (including those applicable to electronic fund transfers subject to Regulation E of the Federal Reserve Board) contained in: (a) the Internet Banking Service Agreement ("the Agreement") which I may access when I log onto the Service, and (b) your general disclosure for personal and business accounts which I received when I opened my account(s). I acknowledge and agree that using, or permitting another person to use, the Service confirms the terms and conditions set forth in the Agreement. I must indicate that I wish to cancel the Service by written notice. Non-usage of the Service for two years may result in either termination of the Service or discontinuance of any service fee waiver at our sole discretion. I agree that any time after such notice or period of non-use, you may discontinue both the Service and/or any waiver of charges that ordinarily apply to this or any other services provided by you. If my Service is discontinued, pending payments and recurring payments that have not been sent will be canceled. I hereby certify that all statements in this application are true and complete and are made for the purpose of obtaining the Service; authorize you to obtain such information as you may require concerning the statements herein; agree that this application shall remain your property; and acknowledge my responsibility to inform you of any change in name, address or employment within a reasonable time. CUSTOMER S AUTHORIZED SIGNATURE: DATE: APPROVING BANK OFFICER S SIGNATURE: DATE: FOR BANK USE ONLY BRANCH RESPONSIBILITY CODE: E-BANKING SETUP COMPLETED BY: DATE: E-BANKING SETUP REVIEWED BY: DATE: KEEP IN A SAFE PLACE OR COMMITT TO MEMORY! Account Access Information USER NAME: PIN: SECRET PASSWORD OR PHRASE (Used to identify the user over the telephone): Page 6 of 6